Case uitwerking
Case 1 Health systems governance
Case 1 of health systems governance
[Meer zien]Voorbeeld 2 van de 10 pagina's
Voorbeeld 2 van de 10 pagina's
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Voorbeeld van de inhoud
Case 1 – health systems analysisLearning goals
1. How can a health system – and its boundaries – be defined, and what are the strengths and
limitations of different definitions?
Duran: Understanding health systems: scope, functions and objectives (2012)
Eventual WHO definition of health system: a health system consists of all organizations, people and
institutions producing actions whose primary intent is to promote, restore or maintain health’.
- Population based
- Personal based
Boundary primary intent is to promote health, is also the definition
Too narrow not all the factors are included, but also determinant that indirect impact health.
Social factors like education, high educated you need less care because of your health
literacy
More things to include:
Prevention for healthcare, to extent your boundaries for the definition.
Health promotion services
Typical activities for health promotion, disease prevention, and wellness programs include:
Communication: Raising awareness about healthy behaviours for the general public. Examples of
communication strategies include public service announcements, health fairs, mass media
campaigns, and newsletters.
Government environment, context etc…
Everything a government does influences health, so influences healthcare. Difficult to have a clear
definition.
Problem with too broad: then everything influences health. Problem from a system perspective: no
boundaries and there cannot be any rules and accountability there.
It also includes: Health services (personal and population based) and the activities to enable their
delivery provided by finance, resource generation and stewardship functions. Stewardship, which
includes activities seeking to influence the positive health impact of other sectors – even though the
primary purpose of those sectors is not to improve health. Example stewardship: BOB campaign.
Personal services are those that are delivered to individuals on a one-to-one basis such as a surgical
operation, a general practice consultation, individual counselling, immunizing a child or supporting a
mother in feeding a child.
Population-based services are those delivered to a group or an entire population; these include
immunization campaigns, warning labels on cigarette packs and workplace health promotion. This
, categorization of services depends on the mode of delivery, it is driven by organizational and
managerial concerns.
Personal services can include interventions that are curative, preventive and promotional (delivered
to individual but also benefits others e.g. treatment of infectious disease).
Population- based services are preventive and promotional but exclude individual treatment.
Health is influenced by actions of sectors whose primary purpose is other than to produce health
(housing, labour or fiscal policies). Health actions: efforts that influences health determinants that lie
outside the health system.
Their primary aim: to promote, preserve or protect health.
Broad definition: Duplessis et al. defined a health system as: “organizations providing health services
(hospital, health care centres, professional officers, and public health services) and also other
networks, sectors, institutions, ministries and organizations which have a definite influence on the
ultimate objective of the system – health. Important in this respect are education, transportation,
social services, housing, the food industry, etc.”
No boundaries
Difficult to use practically
WHO was a little bit smaller
Boundaries:
- No clear view of parts and their interconnections that come together for a purpose.
- If all factors that influence outcomes are included, there are no boundaries and no clarity on the
roles or responsibilities and accountability.
- On the other hand, the very narrow health care definition is unduly limiting, considering health
promotion as outside the boundaries of the health system, for example, would generate unnecessary
fragmentation and may even question the duty of doctors, nurses and health ministries to
incorporate health promotion into their work.
Not all factors are included in the healthcare system. For example healthcare promotion:
government: does it excluded. Not every countries has the same health system, primary intent can
differ. Healthcare team (public health institutions) included, if the government is in charge of it
excluded.
Health is influenced by the actions of sectors whose primary purpose is other than to produce health.
Each day parliaments, private companies and individuals make decisions that affect health, for
example on housing, labour or fiscal policies. These are not included in the definition of a health
system but this should not prevent health authorities from seeking to influence them. In contrast,
efforts to promote healthy public policies so as to influence health determinants that lie outside the
health system are health actions whose primary intent is to promote, preserve or protect health. As
such, they are part of the health system and health authorities should be held accountable for such
actions. This responsibility for influencing other sectors is one of the key dimensions of what is
termed stewardship, within which the WHR2000 includes the ‘incorporate[ion of] selected
intersectoral actions in which the stewards of the health system take responsibility to advocate for
improvements in areas outside their direct control, such as legislation to reduce fatalities from traffic
accidents’. The definition of a health system, therefore, includes:
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